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Intraoperative fluoroscopic-guided balloon choledocholithotomy and laparoscopic cholecystectomy : A new technique for the treatment of choledocholithiasis

Yasunobu Kobayashi, MD1, Hironori Ohdaira, MDPhD1, Mutsumi Kaji, MD1, Norihiko Suzuki, MD1, Satoshi Narihiro, MD1, Taigo Hata, MD1, Soujun Hoshimoto, MDPhD1, Masashi Yoshida, MDPhD1, Jun Horiguchi, MDPhD1, Eigoro Yamanouchi, MDPhD2, Masaki Kitajima, MDPhD1, Yutaka Suzuki, MDPhD1. 1Dept of Surgery, International University of Health and Welfare, 2Dept of Radiology, International University of Health and Welfare

Background: Patients with choledocholithiasis often are undergone preoperative endoscopic retrograde cholangiography (ERCP) following laparoscopic cholecystectomy (LC). However, ERCP has risks of acute pancreatitis, bleeding, and perforation. Consequently, there might be unexpected interval between ERCP and LC.

Objective: We report on a single-stage operation (LC + fluoroscopic-guided balloon choledocholithotomy) as a new technique of treatment for choledocholithiasis.

Patients: From April 2015 to August 2018, 15 patients with choledocholithiasis (male: female = 6 : 9, median 75 (range, 62 – 91) years old)) were enrolled.

Methods: Calot’s triangle were dissected and exposed with the same procedure as conventional LC. Cystic duct was incised, the sheath of angiography catheter  percutaneously was placed through right upper quadrant, and cannulated to cystic duct. Guide wire was inserted with fluoroscopy, and cannulated the duodenum beyond the Vater papilla. Existence of choledocholithiasis was confirmed, Vater papilla was dilated with balloon. Subsequently, the balloon was expanded upstream of the choledocholithiasis and stones ware removed by the extrusion method. Common bile duct was imaged again to confirm that there was no remaining stone. Finally temporally plastic stent was placed.

Results: Operation was completed in all 15 patients, and in all cases stones could be removed. Median operative time was 139 minutes (range, 87-341 minutes) and median fluoroscopic time of stone removal was 45 minutes (range, 7-120 minutes). Median postoperative hospital stay was 3 days (range, 2-11 days). No complications related to surgery were observed in all cases, and it was confirmed that there was no residual stone in the biliary tract by MRCP one month after the operation.

Conclusion: LC + fluoroscopic stone removal technique is safe and reliable and can be one of new treatments for choledocholithiasis.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94394

Program Number: P218

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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